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INTAKE FORM

Please fill out the form and agree to the terms and conditions below.

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Disclosure for hypnosis and related services

By completing this form, I acknowledge that I received, read, and understand this disclosure from Mark R. McAdamsand Back2Balance Solutions, LLC as it relates to hypnosis services as well as otheralternative healing services. I agree to abide by the terms.

Have you been hospitalized in the last 12 months?
Are you suffering from a medical condition, illness, or injury?

Thanks for submitting!

We value your time and kindly request you to take a moment to fill out this form. Your cooperation not only helps us better understand your needs but also signifies your acknowledgment and agreement to the terms and conditions detailed on this webpage. Your trust is of utmost importance to us. Should you have any questions or concerns regarding the terms and conditions, please don't hesitate to reach out to us. 

Please note:

- Mark McAdams is not a licensed physician.


- The treatment is alternative and/or complementary to healing arts services licensed
by the state.

 

- The services to be provided are not licensed by the State of California.

The nature of the services to be provided are:
A ninety-minute hypnosis session of either a past life regression or SMGI© at the
rate of $353 per 90-minute session. Additional 30 minutes will be prorated.
Preferred method of payment is my Venmo account, @Mark-McAdams-3.
50% upon setting a session appointment and the remaining 50% within 24 hours of
the session. This shall apply to any additional sessions booked.
- Each client is different and therefore each experience may vary.
- Practitioners & many researchers believe that hypnosis is a pathway to the
subconscious mind. The subconscious mind controls nearly 95% of our behaviors.
- Mark holds certificates of course work completion in SMGI© as well as Hypnosis and Past Life Regression from the Edgar Cayce A.R.E. in Virginia Beach, VA.

Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Mark R. McAdams and Back2Balance Solutions, LLC from all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).

Terms and Conditions subject to change without notice.

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